Abstract
BackgroundAnemia has been a known prognostic factor in metastatic hormone-sensitive prostate cancer (mHSPC). We therefore examined the effect of anemia on the efficacy of upfront abiraterone acetate (ABI) in patients with mHSPC.MethodsWe retrospectively evaluated 66 mHSPC patients with high tumor burden who received upfront ABI between 2018 and 2020 (upfront ABI group). We divided these patients into two groups: the anemia-ABI group (hemoglobin < 13.0 g/dL, n = 20) and the non-anemia-ABI group (n = 46). The primary objective was to examine the impact of anemia on the progression-free survival (PFS; clinical progression or PC death before development of castration resistant PC) of patients in the upfront ABI group. Secondary objectives included an evaluation of the prognostic significance of upfront ABI and a comparison with a historical cohort (131 mHSPC patients with high tumor burden who received androgen deprivation therapy (ADT/complete androgen blockade [CAB] group) between 2014 and 2019).ResultsWe found that the anemia-ABI group had a significantly shorter PFS than the non-anemia-ABI group. A multivariate Cox regression analysis showed that anemia was an independent prognostic factor of PFS in the upfront ABI group (hazard ratio, 4.66; P = 0.014). Patients in the non-anemia-ABI group were determined to have a significantly longer PFS than those in the non-anemia-ADT/CAB group (n = 68) (P < 0.001). However, no significant difference was observed in the PFS between patients in the anemia-ABI and the anemia-ADT/CAB groups (n = 63). Multivariate analyses showed that upfront ABI could significantly prolong the PFS of patients without anemia (hazard ratio, 0.17; P < 0.001), whereas ABI did not prolong the PFS of patients with anemia.ConclusionPretreatment anemia was a prognostic factor among mHSPC patients who received upfront ABI. Although the upfront ABI significantly improved the PFS of mHSPC patients without anemia, its efficacy in patients with anemia might be limited.
Highlights
Anemia has been a known prognostic factor in metastatic hormone-sensitive prostate cancer
The LATI TUDE trial demonstrated that upfront abiraterone acetate (ABI, a type of androgen receptor-targeted agent [Androgen receptor-targeted agent (ARTA)]) added to androgen deprivation therapy (ADT) can lead to significant benefits in metastatic hormone-sensitive prostate cancer (mHSPC) patients compared with ADT monotherapy [6, 7]
We retrospectively evaluated 563 mHSPC patients with CHAARTED highvolume disease, who were in the Michinoku Japan Urological Cancer Study Group database and who were initially treated with ADT/complete androgen blockade (CAB) between 2008 and 2016 (Michinoku database) [4, 5, 9]
Summary
Anemia has been a known prognostic factor in metastatic hormone-sensitive prostate cancer (mHSPC). The LATI TUDE trial demonstrated that upfront abiraterone acetate (ABI, a type of androgen receptor-targeted agent [ARTA]) added to ADT can lead to significant benefits in mHSPC patients compared with ADT monotherapy [6, 7]. These studies showed an almost similar PFS and overall survival between the ADT monotherapy and upfront ABI groups in the early term of the study [6, 7]. We speculated that some important prognostic and/or predictive factors may be present among patients who received ABI therapy
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